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  • Originally posted by FreshFish View Post
    Gee, so our talented well-intentioned amateurs had no idea that unintended consequences might apply?

    For those who know what PV=nrT means, they'll understand immediately.

    Basically, there are interdependent variables; if you fix two numbers the third number is forced by the laws of nature. (this is about gas, not the political kind nor the biological kind, the physical kind). Out of Pressure, Volume, and Temperature, you can fix two of the three but the third is forced by nature.

    In PPACA, they tried to fix all three of the comparable variables by statute. It is bound to fail. it is a mathematical necessity that it must fail. it is like King Canute ordering the tide to stop rising. you cannot override nature by law no matter how well-intentioned your purpose.
    I've got a better equation for you Fishy! Try this one on for size:

    Romneycare = Obamacare.

    What this mathematical formula proves is that the consequences for a 1/50th representation of the whole is a good harbinger for how a countrywide rollout might take place. The better part is that we also have a six year track record to study.

    So, back to the subject of jobs. In the state of Mass, according to right wing theory, 1) unemployment should be above the national average, 2) businesses would be cutting full time employment and hiring part timers in their place, and 3) state would be overburdened by all these people on the public plan.

    Care to guess at the actual results?
    Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

    Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

    "I've never seen so much reason and bullsh*t contained in ONE MAN."

    Comment


    • Re: The Sad Case of the Patient Protection and Affordable Care Act

      Originally posted by Rover View Post
      Romneycare = Obamacare.
      Wrong. Very, very wrong. very very very very wrong.

      Superficially, Obama"care" appears to resemble Romneycare; however, the details are very different.

      is there a medical devices tax in Romneycare?

      -- um, no.

      Does Romneycare take money from Medicare?

      -- um, no.

      Was the Romneycare mandate found unconstitutional?

      -- um, no.

      (Obama"care" was allowed to stand despite the mandate being found unconstitutional because it was re-interpreted to be an exercise of Congress' power to tax).


      Was Romneycare passed in a bi-partisan manner after negotiations with all involved parties?

      -- why, yes! (ah, Obama"care" received not a single minority party vote and there were no negotiations, "we have to pass it before we know what's in it")
      "Hope is a good thing; maybe the best of things."

      "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

      "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

      "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

      Comment


      • Re: The Sad Case of the Patient Protection and Affordable Care Act

        Originally posted by FreshFish View Post
        Wrong. Very, very wrong. very very very very wrong.

        Superficially, Obama"care" appears to resemble Romneycare; however, the details are very different.

        is there a medical devices tax in Romneycare?

        -- um, no.

        Does Romneycare take money from Medicare?

        -- um, no.

        Was the Romneycare mandate found unconstitutional?

        -- um, no.

        (Obama"care" was allowed to stand despite the mandate being found unconstitutional because it was re-interpreted to be an exercise of Congress' power to tax).


        Was Romneycare passed in a bi-partisan manner after negotiations with all involved parties?

        -- why, yes! (ah, Obama"care" received not a single minority party vote and there were no negotiations, "we have to pass it before we know what's in it")
        Does Romneycare violate religious freedom by mandating coverage for abortions and all forms of contraception? I don't believe so (not an expert, so correct me if I'm wrong).

        Comment


        • Originally posted by FreshFish View Post
          Wrong. Very, very wrong. very very very very wrong.

          Superficially, Obama"care" appears to resemble Romneycare; however, the details are very different.

          is there a medical devices tax in Romneycare?

          -- um, no.

          Does Romneycare take money from Medicare?

          -- um, no.

          Was the Romneycare mandate found unconstitutional?

          -- um, no.

          (Obama"care" was allowed to stand despite the mandate being found unconstitutional because it was re-interpreted to be an exercise of Congress' power to tax).


          Was Romneycare passed in a bi-partisan manner after negotiations with all involved parties?

          -- why, yes! (ah, Obama"care" received not a single minority party vote and there were no negotiations, "we have to pass it before we know what's in it")
          All of this is irrelevant BS. Does each have a mandate? Yes. Do they require businesses to cover their full time employees? Yes. Have businesses started fleeing the state? No. Are employers dropping coverage onto the state? No. Has the state gone bankrupt? No.

          Now, those lovely states of Mississippi, Alabama, West Virginia, and Kentucky all don't have universal health insurance. Funny, but wouldn't one expect those to all have better economies than Mass?
          Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

          Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

          "I've never seen so much reason and bullsh*t contained in ONE MAN."

          Comment


          • Originally posted by goldy_331 View Post
            Does Romneycare violate religious freedom by mandating coverage for abortions and all forms of contraception? I don't believe so (not an expert, so correct me if I'm wrong).
            Ummm...this is Massachusetts. Yes on both counts.
            Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

            Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

            "I've never seen so much reason and bullsh*t contained in ONE MAN."

            Comment


            • Re: The Sad Case of the Patient Protection and Affordable Care Act

              Originally posted by Rover View Post
              Ummm...this is Massachusetts. Yes on both counts.
              Sorry, I went off a Boston Globe article as I assumed they would know what is in Romneycare. I guess they were wrong.

              Comment


              • Originally posted by goldy_331 View Post
                Sorry, I went off a Boston Globe article as I assumed they would know what is in Romneycare. I guess they were wrong.
                Hell even I don't listen to the Globe.
                Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

                Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

                "I've never seen so much reason and bullsh*t contained in ONE MAN."

                Comment


                • Re: The Sad Case of the Patient Protection and Affordable Care Act

                  Originally posted by huskyfan View Post
                  did I post this already? it might not have gone through.

                  why are health related companies - hospitals, medical device companies, pharms, etc - cutting their work forces? wont ObamaCare be being millions into the system? more demand should equal more supply. what am I not getting about?
                  Mass saw a decrease in pharma because they were no longer able to bring people out to dinner/lunch etc or give freebees (no pens, paper, any little gadgets). The pharma reps I talked to said they were allowed to give out medically connected paraphenalia but the companies weren't willing to spend money on that. They don't sample name brands that are generic and right now there aren't a ton of meds coming out. Insurance companies are dictating what we can write for so the rep can talk til they are blue in the face and it won't change what we can access for the pt. Ergo- less pharma reps.

                  Comment


                  • Re: The Sad Case of the Patient Protection and Affordable Care Act

                    http://gma.yahoo.com/doc-shortage-co...ws-health.html (from that hotbed of conservative values, ABC News):

                    The United States will require at least 52,000 more family doctors in the year 2025 to keep up with the growing and increasingly older U.S. population, a new study found.

                    The predictions also reflect the passage of the Affordable Care Act -- a change that will expand health insurance coverage to an additional 38 million Americans.

                    "The health care consumer that values the relationship with a personal physician, particularly in areas already struggling with access to primary care physicians should be aware of potential access challenges that they may face in the future if the production of primary care physicians does not increase," said Dr. Andrew Bazemore, director of the Robert Graham Center for Policy Studies in Primary Care and co-author of the study published Monday in the Annals of Family Medicine.

                    .....

                    The problem does not appear to be one of too few doctors in general; in fact, in 2011 a total of 17,364 new doctors emerged from the country's medical schools, according to the Association of American Medical Colleges (AAMC). Too few of these doctors, however, choose primary care as a career -- an issue that may be worsening. [emphasis added]

                    ....

                    It's pretty tough to convince medical students to go into primary care," said Dr. Lee Green, chair of Family Medicine at the University of Alberta, who was not involved with the study.

                    Green added that he believes this is because currently primary care specialties are not well paid, well treated or respected as compared to subspecialists.

                    ....

                    Perhaps the best known example of this approach has been Massachusetts, which since 2006 has mandated that every resident obtain health insurance and those that are below the federal poverty level gain free access to health care. But although the state has the second-highest ratio of primary care physicians to population of any state, they are struggling with access to primary care physicians. [emphasis added]

                    Dr. Randy Wexler of The John Glenn Institute of Public Service and Policy said he has concerns that this trend could be reflected nationwide.

                    "Who is going to care for these people?" he said. "We are going to have problems just like Massachusetts. [They] are struggling with access problems; it takes one year to get into a primary care physician. Coverage does not equal access." [emphasis added]

                    Great, now everyone has insurance, and no one new to the system can find a primary care physician. Isn't that what once was called "throwing the baby out with the bathwater" ?
                    "Hope is a good thing; maybe the best of things."

                    "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                    "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                    "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                    Comment


                    • Originally posted by FreshFish View Post
                      http://gma.yahoo.com/doc-shortage-co...ws-health.html (from that hotbed of conservative values, ABC News):




                      Great, now everyone has insurance, and no one new to the system can find a primary care physician. Isn't that what once was called "throwing the baby out with the bathwater" ?
                      I'll defer to les and co on this one, but hasn't a shortage of primary care physicians been a problem for like the last 20 years, as in long before Romneycare/Obamacare?
                      Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

                      Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

                      "I've never seen so much reason and bullsh*t contained in ONE MAN."

                      Comment


                      • Re: The Sad Case of the Patient Protection and Affordable Care Act

                        Originally posted by Rover View Post
                        I'll defer to les and co on this one, but hasn't a shortage of primary care physicians been a problem for like the last 20 years, as in long before Romneycare/Obamacare?
                        This isn't news. It isn't even old news. Specialists get paid sig more and have way less responsibility in the current system. The primary care people are getting more and more responsibility and no renumeration to go with it. Mass had an immediate shortage that persists in primary care. If a practice is any good it rarely is open to new patients in our area.

                        Until they start paying the primary practice for all the things they think we should do this will persist. Why does an ENT's med asst get paid 250 to irrigate and ear and we get 80$? Our reimbursement for care is not as high as the specialist. Top that with all the punishments the insurance companies heap on us if the patient is non-compliant and we practically pay to take care of the pt. See various rants in this and previous threads

                        Comment


                        • Re: The Sad Case of the Patient Protection and Affordable Care Act

                          Status of exchanges in the states: http://healthreform.kff.org/state-ex...iles-page.aspx
                          HHS Draft regs: http://cciio.cms.gov/resources/files...nt05162012.pdf
                          CCT '77 & '78
                          4 kids
                          5 grandsons (BCA 7/09, CJA 5/14, JDL 8/14, JFL 6/16, PJL 7/18)
                          1 granddaughter (EML 4/18)

                          ”Any society that would give up a little liberty to gain a little security will deserve neither and lose both.”
                          - Benjamin Franklin

                          Banned from the St. Lawrence University Facebook page - March 2016 (But I got better).

                          I want to live forever. So far, so good.

                          Comment


                          • Re: The Sad Case of the Patient Protection and Affordable Care Act

                            Originally posted by leswp1 View Post
                            This isn't news. .... Mass had an immediate shortage that persists in primary care. If a practice is any good it rarely is open to new patients in our area.

                            YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

                            It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.
                            "Hope is a good thing; maybe the best of things."

                            "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                            "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                            "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                            Comment


                            • Re: The Sad Case of the Patient Protection and Affordable Care Act

                              Originally posted by leswp1 View Post
                              This isn't news. It isn't even old news. Specialists get paid sig more and have way less responsibility in the current system. The primary care people are getting more and more responsibility and no renumeration to go with it. Mass had an immediate shortage that persists in primary care. If a practice is any good it rarely is open to new patients in our area.

                              Until they start paying the primary practice for all the things they think we should do this will persist. Why does an ENT's med asst get paid 250 to irrigate and ear and we get 80$? Our reimbursement for care is not as high as the specialist. Top that with all the punishments the insurance companies heap on us if the patient is non-compliant and we practically pay to take care of the pt. See various rants in this and previous threads
                              Was not going to join the chat but Les always makes me do some thinking. Why do we have this wide differencial in remuneration for physicians? Who made up the numbers and who decided what each tiny little thing we did got paid for and how much? Who assigned codes for everything and who decided what the remuneration was for each carefully coded item? Did practicing physicians cause this situation or even play a big part in it? Anyone with medical practice experience will tell you how ridiculous this entire system of coding and reimbursement is. Even trying to figure out how to do this properly and adhere to the coding guidelines often causes an office to hire someone just for that purpose. And then once you have it down pat, stupid as it may be, they change it and you have to learn all new codes and their uses.

                              From personal experience-whoever devised this wonderful system decided that i should be reimbursed more for taking off a benign tiny growth on the face than I received for doing a much more complicated excision of a cancer on the chest(which also necessitated far more time and expertise and careful follow up visits).

                              Doctors are not stupid people (except when it comes to investing and perhaps politics) So they quickly figured that you could spend a morning as a gastroenterologist doing a series of expensively reimbursed procedures (endoscopies, colonoscopies, etc) at their local outpatient surgical facility and collect a tidy sum of money versus spending all day in the office with patients taking medical histories, doing physical exams, and prescribing and counseling and collect 1/10th or less in revenue. Now, what would you choose? 3 hours performing 6 of these 20-30 minute procedures at a couple thousand each or spending all day seeing 40 patients in the office at perhaps $50 a piece? I used gastroenterology as an example but the same thing virtually happens with almost any specialty. The things that the coding system rewards are the things that the doctors are going to try to do more often-sometimes even when they are not needed.

                              Primary care physicians usually do not have that luxury-most of what they do is see a patient, take a history, perform a physical examination, and then either counsel or prescribe. But all of that takes considerable time and because the coding only allows the entire time as an office visit (between level 1 and 5 in value depending on all sorts of factors that make very little sense-since often they do not reflect the seriousness of the problem). Who, beside the truly devoted, would ever make the choice to enter the field of primary practice medicine when they had the choice to work less hours, see less people, perform more procedures and receive an incredibly larger amount of money for doing it?

                              I do not dare suggest that I have the solution to this problem. But certainly having these decisions about reimbursement left to people who have no clue about the practice of medicine. Or to people who have a financial interest in these decisions (insurance companies, the government, etc) just has not worked. Way back in the old days-before all of this coding and reimbursement being based on criteria that make little sense-specialists still made a better living than primary care physicians. That was probably the case ever since the age of specialization began. But the differential was not nearly as great. When I graduated medical school-40+ years ago-about 1/2 our graduating class intended to be primary physicians. If i was able to go back further perhaps that figure would have even been higher. Today, the number who even consider it has dwindled to a minute percentage.
                              Take the shortest distance to the puck and arrive in ill humor

                              Comment


                              • Re: The Sad Case of the Patient Protection and Affordable Care Act

                                Originally posted by FreshFish View Post
                                YES! Exactly. Many physicians are retiring now rather than deal with the incremental extra reporting requirements under PPACA, while you simultaneously add lots of new patients to the system. Result: longer wait times.

                                It's only news to Rover apparently and he is so good at denial I imagine he is singing at the top of his lungs right now with his fingers stuck firmly in his ears.
                                Fish-Most of my cohorts have indeed retired or are considering it precisely for that reason. Jenny and I are losing all our personal physicians-and honestly we no longer have a primary care physician at all. If we did not have the medical training ourselves, we would not know who to see for anything.
                                Take the shortest distance to the puck and arrive in ill humor

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